Gestational Diabetes: Managing Risk During and After Pregnancy

Posted by Brigham and Women's Hospital October 6, 2015

The initial approach to treating gestational diabetes mellitus is to control a mother’s blood glucose levels with healthy eating and physical activity.

Contributor: Ellen Seely, MD, is the Director of Clinical Research in the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital and Professor of Medicine at Harvard Medical School.

Women who develop diabetes during pregnancy, known as gestational diabetes mellitus (GDM),  may need high-risk pregnancy care due to complications that can arise during pregnancy and childbirth. Women with GDM have an increased risk of preeclampsia, a condition that leads to pregnancy- induced high blood pressure. Preeclampsia is a serious condition that can result in early delivery. Women who have gestational diabetes also have an increased risk of cesarean section.

What Causes Gestational Diabetes?

GDM is a type of diabetes that occurs only in pregnancy. It comes on in the second half of pregnancy, and it goes away after delivery. Obesity is one of the main risk factors for GDM. In the United States, most health centers screen all women for gestational diabetes, because obesity is becoming so common in the overall population. It’s estimated that five percent of all pregnancies are complicated by GDM. The rates of GDM are even higher in Hispanic and non-white populations, ranging from 10 to 20 percent of pregnancies.

The primary treatment for GDM is to control a mother’s blood glucose levels with lifestyle changes such as healthy eating and physical activity. Lifestyle changes are effective in controlling blood glucose levels in about 60-75 percent of women with GDM. If the lifestyle changes don’t work, insulin therapy will be started to control a mother’s blood sugar for the rest of her pregnancy.

Gestational Diabetes and Your Future Health

While GDM goes away after pregnancy, the health risks to a mother and her child continue.. Research has found that 50 to 70 percent of women who have gestational diabetes develop type 2 diabetes later in life. Research also has found that babies born to mothers with GDM have a higher birth weight and may become obese during adolescence, increasing their risk of developing diabetes and other conditions, such as high blood pressure. Dr. Seely emphasizes that although women who have had gestational diabetes face an increased future risk for type 2 diabetes, they can take steps to decrease that risk.

In the video below, Dr. Seely discusses the health risks associated with GDM during and after pregnancy. Dr. Seely also describes Balance after Baby, a web-based pilot program designed to educate women on eating healthfully and increasing their physical activity, with the goal of helping them lose their pregnancy weight within a year of giving birth.

Learn more:

– Jamie R. 

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Understanding Bariatric Surgery Treatment Options

Posted by Brigham and Women's Hospital July 9, 2014

After having a sleeve gastrectomy, Chuck achieved optimal cholesterol and blood pressure levels, his sleep apnea was cured, his diabetes went into remission, and he welcomed his first child.

Obesity is a major public health problem in the United States and throughout the world. In the U.S., it is estimated there are up to 20 million morbidly obese people (body mass index (BMI) greater than 40). Morbid obesity can lead to many other health issues, including type 2 diabetes, high blood pressure, and sleep apnea. These patients also may be at increased risk for certain types of cancer, endocrine problems, skin problems, and joint and bone pain.

Bariatric surgery (weight loss surgery) can help patients with a BMI greater than 40, or a BMI greater than 35 with co-existing health conditions, lose weight  and improve their overall health, including remission of type 2 diabetes, reductions in high blood pressure, and improvement in female fertility.

Dr. Scott Shikora, Director of the Center for Metabolic Health and Bariatric Surgery at Brigham and Women’s Hospital discusses bariatric surgery options for weight loss and metabolic treatment in obese patients.

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What’s the Big Deal about Salt?

Posted by Brigham and Women's Hospital August 28, 2013

Excess sodium intake not only increases blood pressure, but also increases the risk for heart disease and stroke.

Today’s post is written by Kathy McManus, MS, RD, LDN, Director, Department of Nutrition and Nutrition Director, Program for Weight Management. The post originally appeared in the Healthy 850 Newsletter, published by the Osher Clinical Center for Integrative Medicine.

Some consumers believe that dietary salt (sodium) is only a concern if they have high blood pressure; not true. Excess sodium intake not only increases blood pressure, but also increases the risk for heart disease and stroke. Heart disease and stroke are the leading causes of death in the US. The American Heart Association (AHA) reports that 97 percent of children and adolescents eat too much salt, putting them at greater risk for cardiovascular disease as they age.

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A Hearty Dose of Cardiovascular Advice and Research

Posted by Brigham and Women's Hospital February 12, 2013

Heart disease continues to be the leading cause of death for both men and women in the United States, and it is also one of the leading causes of disability. As part of American Heart Month, we offer insight from our clinicians and researchers about how to reduce your heart disease risks and what new things we’re learning about cardiovascular disease and treatment.

 

Heart Disease: Eliminate Excuses to Reduce Your Risks

Dr. Eldrin F. Lewis, MD, MPH, tells his patients that they’ll dramatically reduce their risk of developing heart disease if they follow a few simple guidelines for reducing their blood pressure (hypertension). Genetics can indeed play a role in developing high blood pressure, but obesity, inactivity, tobacco and alcohol use, stress, and salt intake are all hypertension risk factors that you can  control.

 

Weighing the Benefits and Risks of Cholesterol Drugs

If you’ve been taking a statin medication to lower your cholesterol, you might be wondering what you should do in light of new warnings about the link between statin use and diabetes. Research conducted at Brigham and Women’s Hospital may help you and your doctor weigh the benefits and risks.

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Bariatric Surgery: It’s Not Just about Weight Loss

Posted by Brigham and Women's Hospital January 24, 2013

Evidence suggests that bariatric surgery can be an effective treatment for a variety of metabolic conditions, including type 2 diabetes and high blood pressure.

Although bariatric surgery has proven to be an effective and lasting treatment for morbid obesity, mounting evidence suggests that the benefits go far beyond weight loss. Our patients Chuck and Theresa, both featured in our blog earlier this week, are just two examples of how bariatric surgery can improve your health in ways that aren’t experienced through other weight loss approaches.

According to Dr. Scott Shikora, Director, Center for Metabolic Health and Bariatric Surgery at Brigham and Women’s Hospital, the ultimate goals of weight loss surgery should be the health benefits, not just the weight loss. He explains that most of us are aware that bariatric surgery can lead to dramatic weight loss and a corresponding increase in self-esteem, but many of us don’t realize how many metabolic diseases and conditions can be effectively treated through weight loss surgery.

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Heart Disease: Eliminate Excuses to Reduce Your Risks

Posted by Brigham and Women's Hospital December 18, 2012

Dr. Lewis tells his patients that one or more lifestyle changes can dramatically reduce their risk of developing heart disease.

Brigham and Women’s Hospital cardiologist Eldrin F. Lewis, MD, MPH, specializes in evaluating patients with heart failure. His goal, however, is to prevent patients from ever needing his expertise.

Knowing that high blood pressure (hypertension) is the biggest risk factor for heart failure, Dr. Lewis tells his patients that they’ll dramatically reduce their risk of developing heart disease if they follow a few simple hypertension-reducing guidelines and keep an eye on their blood pressure. Genetics can indeed play a role in developing high blood pressure, but obesity, inactivity, tobacco and alcohol use, stress, and salt intake are all hypertension risk factors that you can control.

“Eliminate excuses from your vocabulary,” says Dr. Lewis. As a physician with a family history of high blood pressure, that’s what he has tried to do.

  • Know your blood pressure

Left untreated, high blood pressure can cause heart attacks, stroke, kidney failure, or heart failure.  Unfortunately, many people are unaware of their blood pressure levels. Since mild to moderate hypertension usually doesn’t come with any symptoms, you won’t know whether you have it unless you get your blood pressure checked.

There’s no excuse for not knowing your blood pressure, says Dr. Lewis. Everyone should have their blood pressure checked at least once a year, and thanks to the Affordable Care Act, you now can get your yearly physical for free. People at risk or who have already been diagnosed with hypertension, however, should check their blood pressure more frequently. This can be done at your doctor’s office or on your own.

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Making Headway on Beta-Blockers and Sleep

Posted by Brigham and Women's Hospital November 14, 2012

Patients who take high blood pressure medication often have trouble sleeping.

It’s three in the morning and you’re wide awake.  If you’re taking a medication known as a beta-blocker, you may find this happens more often than you’d like.

Over 20 million people in the United States take beta-blockers, a medication commonly prescribed for cardiovascular issues, anxiety, hypertension (high blood pressure), and more. Many of these same people also have trouble sleeping.  Beta-blockers are known to block the body’s production of melatonin, a hormone that helps regulate the body’s sleep cycles.  Researchers at Brigham and Women’s Hospital (BWH) have found that giving patients melatonin supplements at night improved sleep in patients taking beta-blockers.

“Beta-blockers have long been associated with sleep disturbances, yet until now, there have been no clinical studies that tested whether melatonin supplementation can improve sleep in these patients,” explained Frank Scheer, PhD, MSc, an associate neuroscientist at BWH, and principal investigator on this study. “We found that melatonin supplements significantly improved sleep.”

The research team analyzed 16 patients who regularly took beta-blockers as treatment for high blood pressure. The study subjects were given either a melatonin supplement or placebo before bed each night; neither the subjects nor the researchers knew which pill the patients were taking.

Analyzing the subjects’ sleep patterns, researchers found, on average, that subjects who received the melatonin supplement slept 37 minutes longer compared to those who received a placebo.  Patients taking melatonin also spent more time in Stage 2 sleep, the most prevalent stage.  There was no significant difference in the amount of time spent in the other stages of sleep between patients on a placebo and those taking melatonin.

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